Forms & Information
Summary of Benefits
The Summary of Benefits describes some features of our plans, including premiums and cost-sharing. It doesn't list every service that we cover, or every limitation or exclusion.
Evidence of Coverage
The Evidence of Coverage or "EOC" gives you complete details about your New West Medicare plan benefits, premiums, and cost-sharing amounts.
How to request a retroactive authorization of medical services (pdf)
You, your doctor, or your representative can request a decision about Medicare care or services, called a “coverage determination” or “organization determination”, by calling, writing, or faxing us at:
1-800-290-3657, TTY 711, choose Option 2
Hours are 8:00 am to 8:00pm daily.
New West Health Services
Attn: Medical Services
130 Neill Avenue
Helena MT 59601
Please also refer to your Evidence of Coverage, Chapter 9 for more information.
Other resources and forms
Learn about the Silver & Fit exercise and healthy aging program
HIPAA authorized representative form (pdf)
You have the right to elect someone to help you with your claims and discuss your coverage. If you need this assistance, this form tells you how to make that arrangement.